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4 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWNFAC) Revis 5/14/93 <br /> NEW FACILITY i CHANGE OF OWNER DATE OF OWNER CHANGE / / INACTIVE <br /> Prior Owner <br /> UNDER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANGE / / DELETE <br /> -11 OWNER FILE <br /> e <br /> OWNER ID C 3 - CASE BILLING PARTY Y / <br /> OWNER NAMEy//yJ �1 OWNER HOME PHONE ( ) <br /> OWNER DBA v/ /— OWNER WRK/BUS PH ( ) <br /> ADDRESS <br /> CITY /` STATE ZIP / �;72O 3 <br /> MAILING ADDRESS <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID BILLING PARTY Y / <br /> A,4 <br /> * OF EMPLOYEES <br /> FACILITY NAME / /`4 `'""r TRUST LANDS? Y / N <br /> FACILITY ADDRESS ( / " " 4L Z)'p— HOME PH ( ) <br /> CROSS STREET BUSN PH <br /> CITY C �(� N STATE / ' ZIP <br /> [---C—,,,7s --------- SOS Dist Location Code U ( City Code ---------'- <br /> MAILING ADDRESS APN 9 <br /> CARE OF SIC CODE <br /> CITY STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFOTTRM\ATTION <br /> NAME ��N U J' HOME PHONE ( ) <br /> MAILING ADDRESS 6 0 0 Y�^ `5 BUSN PHONE ( ) <br /> CARE OF <br /> 7—CITY <br /> CITY 4 • aJ C�7`� STATE / ZIP 162- <br />